Wednesday, May 16, 2012

Q. I thought I had completed my family, and was confident of never getting pregnant again because I had an IUD. So we bought an individual family plan from Blue Shield of California that excludes pregnancy. But I got pregnant anyway. I asked to be moved to a plan that covers pregnancy, and was denied because of my "pre-existing condition." Is this legit?

A. It sure is. In every health-plan underwriting manual I have ever seen, pregnancy is on the list of conditions that will get you turned down flat for new individual coverage.Moreover, the vast majority of health plans sold to individuals exclude maternity coverage. A recent study of some 3,300 individual policies by the National Women's Law Center, a Washington, D.C. advocacy group, found that only 12 percent included maternity coverage, and half of those were in the handful of states with laws that require it. In a few states, including Colorado, Connecticut, Nevada, and South Carolina, not a single plan available to a 30-year-old woman included maternity coverage.

In other states, you can get limited maternity coverage through an add-on rider that costs extra, but typically must wait a year or more before the benefits kick in, meanwhile paying an additional premium that may cost more than the basic policy itself.

"You can buy coverage in $1,000 or $2,000 increments, but by the time you've waited, you get back $100 or so if it's a normal delivery," says Judy Waxman, the center's vice president for health and reproductive rights. "It's just not worth it."This is one of many ways that individual health insurance is inferior to group coverage, which has included maternity care without exception for years.

But you, dear California resident, are in luck. Last year, California became the ninth state to pass a law requiring all individual health plans to cover maternity care. The new law takes effect July 1, 2012. According to a spokeswoman for Blue Shield of California, as of that date, the new benefit will automatically be added to all the company's individual plans, starting immediately. If your due date is any time after that, your remaining expenses for prenatal care and delivery will be covered.

The Affordable Care Act, aka Obamacare, will fix this problem for good. As of Jan. 1, 2014, all individual health plans sold in the U.S. must include maternity coverage. And you can sign up for a plan even if you're already pregnant, because insurers won't be able to turn you down for any pre-existing condition.

Yes dear readers, Obamacare will "fix" all that. Starting in 2014 all major medical plans will be required to cover maternity. Not only will men have to pay for maternity coverage, but so will pre-menstrual girls, post-menopausal women, sterilized women and those who, for any number of reasons, are unable to get pregnant.

Everyone will see their rates increase. How much? We will get an idea by looking at California.

Expect Dave Fluker to post something on his blog as soon as July rates are released, but don't expect it to be pretty.

Q. I thought I had completed my family, and was confident of never getting pregnant again because I had an IUD. So we bought an individual family plan from Blue Shield of California that excludes pregnancy. But I got pregnant anyway. I asked to be moved to a plan that covers pregnancy, and was denied because of my "pre-existing condition." Is this legit?

A. It sure is. In every health-plan underwriting manual I have ever seen, pregnancy is on the list of conditions that will get you turned down flat for new individual coverage.Moreover, the vast majority of health plans sold to individuals exclude maternity coverage. A recent study of some 3,300 individual policies by the National Women's Law Center, a Washington, D.C. advocacy group, found that only 12 percent included maternity coverage, and half of those were in the handful of states with laws that require it. In a few states, including Colorado, Connecticut, Nevada, and South Carolina, not a single plan available to a 30-year-old woman included maternity coverage.

In other states, you can get limited maternity coverage through an add-on rider that costs extra, but typically must wait a year or more before the benefits kick in, meanwhile paying an additional premium that may cost more than the basic policy itself.

"You can buy coverage in $1,000 or $2,000 increments, but by the time you've waited, you get back $100 or so if it's a normal delivery," says Judy Waxman, the center's vice president for health and reproductive rights. "It's just not worth it."This is one of many ways that individual health insurance is inferior to group coverage, which has included maternity care without exception for years.

But you, dear California resident, are in luck. Last year, California became the ninth state to pass a law requiring all individual health plans to cover maternity care. The new law takes effect July 1, 2012. According to a spokeswoman for Blue Shield of California, as of that date, the new benefit will automatically be added to all the company's individual plans, starting immediately. If your due date is any time after that, your remaining expenses for prenatal care and delivery will be covered.

The Affordable Care Act, aka Obamacare, will fix this problem for good. As of Jan. 1, 2014, all individual health plans sold in the U.S. must include maternity coverage. And you can sign up for a plan even if you're already pregnant, because insurers won't be able to turn you down for any pre-existing condition.

Yes dear readers, Obamacare will "fix" all that. Starting in 2014 all major medical plans will be required to cover maternity. Not only will men have to pay for maternity coverage, but so will pre-menstrual girls, post-menopausal women, sterilized women and those who, for any number of reasons, are unable to get pregnant.

Everyone will see their rates increase. How much? We will get an idea by looking at California.

Expect Dave Fluker to post something on his blog as soon as July rates are released, but don't expect it to be pretty.